Individual
WYATT HENKENIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
285 FOREST GROVE DR, PEWAUKEE, WI 53072-3782
(641) 745-9378
Mailing address
1076 JASPER DR, WEST DES MOINES, IA 50266-3312
(641) 745-9378
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
083438
IA
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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